DRG Claims Management

About DRG Claims Management

It’s fair to say that “not all DRG vendors are created equal.” Despite overlapping marketing efforts, there are two general categories of DRG auditing products: those that primarily serve provider hospitals and those that are designed to identify overpayments on behalf of health plans and payers. Just as an attorney typically specializes in defense or plaintiff representation, auditing vendors specialize in the unique needs, cultures and priorities of the parties they respectively serve. Even within the category of payer-based vendors, there is also a wide range of approaches to DRG auditing and overpayment identification. We extend our scope of services to our physician review team to produce clinical validation findings for situations where the identified issues are unsubstantiated clinical diagnoses documented by treating physicians and therefore exceeds the scope of coders. Our results prove that our coding compliance model will produce verified savings.